LAUSR

(the mean exposure was just 4 pack-years). To truly reduce the burden of COPD, we will need to understand the complexities of its natural history, profile of risk factors, and phenotypic manifestations across the entire lifespan. The study by Çolak and colleagues is an important starting point to characterize COPD in the first 50 years of life. Although the importance of smoking cessation cannot be overemphasized, we argue that understanding the interplay among smoking, early life risk factors, and developmental processes in age spans that have been traditionally left out of COPD research will be key to fully advance prevention strategies for stages when the natural history of the disease can still be substantially modified. n